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Intensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called ‘alarm fatigue’ and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation.
Salmonellae are gram-negative motile bacilli. The transmission of salmonellae to a susceptible host usually occurs from the consumption of contaminated foods. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts four to seven days, but can be severe enough to require hospitalization.
Describe a hospital kitchen based mass foodborne infection.
Descriptive analysis of the foodborne infection event.
310 health personnel were contaminated from lunch that was cooked at our hospital kitchen. On that day 70 patients came to the emergency department for complaints of vomiting, fever, and diarrhea. During the next two days, we canceled all planned surgical operations. At the second day, we followed 80 patients and third day 150 patients came to our emergency services. Our emergency services and ıntensive care units were blocked because of personnel illness. We examined all patients, got blood tests and stool stains and cultures. Because of this mass casualty contamination, our infection control committee gave formal information that suspicious of Salmonellosis. 13 of 310 infected health personnel were hospitalized. They got intravenous saline and electrolytes support like calcium and potassium. After two days we got Results of stool cultures, there was inoculation of Salmonella types. None of them died.
We realized that we are not ready for mass casualty incidents like this contamination. Because our patient flow was really blocked. We had to call in new doctors and nurses from different hospital staffs. The event was similar to bioterrorism conditions and we suddenly have to put in place hospital disaster plans at the beginning of decontamination. This situation made us to recognize bioterrorism agents like Salmonella types. We have to raise awareness of the community about chemical, biological, radiological and nuclear agents attacks.
Turkey is vulnerable to many natural hazards, including earthquakes, landslides, floods, and terrorist attacks. The 7.1 magnitude Marmara Earthquake in 1999 resulted in over 18,000 deaths and estimated losses of over $28 billion. The country’s largest city, Istanbul, is located on the North Anatolian Fault and thus highly prone to earthquakes. It is estimated more than half of the population in the country are potentially seismically vulnerable. This vulnerability makes us ready for disasters. Turkey has advanced disaster risk management through initiating reforms to better manage and reduce disaster risk and strengthening institutions.
To overcome institutional fragmentation, the government established the Disaster and Emergency Management Presidency (AFAD) in 2009.
Assess the 2015 government adopted Turkey National Disaster Response Plan to guide all disaster and emergency response.
In the last six years, Turkey has become one of the world’s largest refugee-hosting countries. As of 2018, approximately 3.5 million Syrians under temporary protection have largely been integrated into cities, towns, and villages that stressing the infrastructure and increasing potential risk exposure. This situation makes us recognize disaster protection preparedness. We have many public and civil institutions to prepare society for unexpected situations. The main institution is the Disaster and Emergency Management Presidency. AFAD has many projects for youth, school children and all age groups of society. The second organization is the Red Crescent organization of Turkey. The other organizations are mainly National Medical Rescue Teams (UMKE), some university disaster clubs, and civil institutions like Beşir NGOs.
These institutions give main disaster confidence education, main CBRN education, main fire-fighting education, camping life educations, orienteering, mobile oven, and kitchen facilities and drills. We have to raise awareness of the community about preparedness to disasters. We have to share lessons with the whole population for reducing social and economic loss.
To investigate oxidative stress parameters [total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), paraoxonase (PON), arylesterase (ARE) and thiol-disulphide homeostasis] in patients who were diagnosed as having somatic symptom disorder in accordance with Diagnostic and Statistical Manual of Mental Disorders-5.
The study included 41 medication-free patients with somatic symptom disorder and 47 age, sex, and sociodemographic-matched healthy individuals. The patients were administered the Patient Health Questionnaire-15, Somatic Symptom Amplification Scale, Beck Depression Inventory, and Beck Anxiety Inventory. TOS, TAS, OSI, PON, ARE thiol, disulphide levels, and routine biochemical parameters were compared between the two groups.
TOS, OSI, disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios were found significantly higher in the patient group compared with the control group (p < 0.001). There was no significant difference in PON, ARE, and TAS parameters between the two groups (p > 0.05).
This study showed that the level of oxidants increased and oxidative balance was impaired in somatic symptom disorder. Oxidative stress may play a role in the aetiopathogenesis of this disorder. This is the first study to report an association between oxidative stress and somatic symptom disorder.
To evaluate the plasma levels of endothelial cell-specific molecule-1 (ESM-1) and pentraxin-3 (PTX-3) in patients with idiopathic sudden sensorineural hearing loss, and to compare the pre- and post-treatment levels in patients responsive and non-responsive to therapy.
The study included 108 subjects: 51 with idiopathic sudden sensorineural hearing loss and 57 controls. For ESM-1 and PTX-3 analyses, blood samples were collected before and three months after treatment initiation in the idiopathic sudden sensorineural hearing loss group and once for the control group. Treatment response was evaluated three months after therapy initiation with pure tone audiometry, and the patients were divided into two groups: responsive and non-responsive to treatment.
Serum ESM-1 levels were significantly higher in the idiopathic sudden sensorineural hearing loss group than the control group, whereas the difference was not significant for PTX-3. In the responsive and non-responsive groups, ESM-1 and PTX-3 levels were not statistically different before and after treatment.
To our knowledge, this is the first study investigating plasma ESM-1 and PTX-3 levels in idiopathic sudden sensorineural hearing loss. Increased plasma ESM-1 levels may confirm endothelial dysfunction involvement in idiopathic sudden sensorineural hearing loss pathogenesis, which could be associated with vascular impairment.
Adiponectin and leptin are involved in appetite control and body weight regulation. We aimed to evaluate the relationship between breast milk adipokine levels and short-term growth of preterm and term infants. Thirty-one preterm (median=35.3 weeks) and 34 term (median=38.7 weeks) infants were enrolled. Enzyme-linked immunosorbent assay was used to detect adipokines in mature milk. Infant growth was followed during the first 3 months. Although weight gain in the first month was insufficient, positive linear growth was observed in the following months for preterm infants, while term infants had positive steady linear growth. The median level of adipokines was found to be higher in preterm infants (P>0.05). Adiponectin showed significant negative correlations with some anthropometric measurements of term infants. However, in preterm infants, adiponectin was negatively correlated with length increment and positively correlated with body mass index (BMI) increment in the second–third month. In addition, leptin was negatively associated with the head circumference at birth in preterm infants and the triceps skinfold thickness increment in the first–second month term infants (P<0.05). In linear regression models, while gestational age, adiponectin and leptin were not related, maternal age and pre-pregnancy BMI had effects on body weight increment in 0–1 months (P<0.05). In conclusion, adiponectin may affect short-term growth, while leptin has no important effect. It would be beneficial to carry out longitudinal studies to evaluate the effects of these adipokines on the growth of infants.
Although the role of neurotrophins such as nerve growth factor and brain-derived neurotrophic factor in nasal polyps development has been studied, the contribution of neurotrophin-3 has not been evaluated yet. This study aimed to investigate the possible role of neurotrophin-3 in nasal polyps pathogenesis.
The study group comprised 70 non-allergic nasal polyps patients and the control group consisted of 53 patients with middle turbinate concha bullosa. Specimens were taken, during surgery, from the ethmoid sinus nasal polyps in the nasal polyps group and from the lateral part of the middle turbinate concha bullosa in the control group. Tissue and serum levels of neurotrophin-3 were assessed by immunohistochemistry and enzyme-linked immunosorbent assay, respectively.
Nasal polyps patients had higher tissue neurotrophin-3 scores (p < 0.001). There was no statistically significant difference between groups regarding serum neurotrophin-3 levels (p = 0.417). Tissue neurotrophin-3 staining scores in the nasal polyps group had no statistically significant correlation with Lund–Mackay scores (p = 0.792).
Neurotrophin-3 may have a local effect in nasal polyps pathogenesis, without joining systemic circulation.
The Late Cretaceous – Recent West Black Sea Basin and the Eocene–Oligocene Thrace Basin are separated by the Strandja arch comprising metamorphic and magmatic rocks. Since Late Cretaceous time the Strandja arch formed a palaeo-high separating the two basins which accumulated clastic sediment of >9 km thickness. During late Eocene – early Oligocene time the marine connection between these basins existed through the Çatalca gap west of Istanbul. The Çatalca gap lies on the damage zone of a major Cretaceous strike-slip fault; it formed a 15 km wide marine gateway, where carbonate-rich sediments of thickness c. 350 m were deposited. The sequence consists of upper Eocene shallow marine limestones (SBZ18-20) overlain by upper Eocene – lower Oligocene (P16-P19 zones) pelagic marl with a rich fauna of planktonic foraminifera; the marls are intercalated with 31–32 Ma acidic tuff and calc-arenite beds. The Çatalca gap is bounded in the west by a major normal fault, which marks the eastern boundary of the Thrace Basin. Seismic reflection profiles, well data and zircon U–Pb ages indicate that the Thrace Basin sequence west of the fault is late Eocene – middle Oligocene (37–27 Ma) in age and that the fault has accommodated 2 km of subsidence. Although there was a marine connection between the West Black Sea and Thrace basins during late Eocene – early Oligocene time, no significant exchange of clastic sediment took place. Sedimentation in the Çatalca gap ended abruptly during early Oligocene time by uplift, and this eventually led to the paralic conditions in the Thrace Basin.
The invasive alien mytilid species, Brachidontes pharaonis, forms a biogenic habitat in the mediolittoral and upper-infralittoral zones of the Levantine Sea, hosting a number of alien and native species. Examinations of samples taken from dense, continuous mussel beds at seven stations along the coast of northern Levantine Sea yielded 187 macro-benthic invertebrate species belonging to 11 taxonomic groups. Polychaeta accounted for 46% and 37% of the total number of species and individuals, respectively. The top three dominant species in the mussel beds were Stenothoe gallensis, Spirobranchus kraussi and Mytilaster minimus. The species with the highest frequency values on the mussel beds were Pseudonereis anomala, Phascolosoma stephensoni and Elasmopus pocillimanus. The highest density and biomass of the associated fauna were estimated as 42,550 ind m−2 and 1503 wwt g m−2, respectively. The species number in samples varied between 14 and 47 species. The environmental variables best explaining variations in zoobenthic community structures were salinity, dissolved oxygen and total inorganic nitrogen in the water column. The biotic indices, TUBI and ALEX, classified the ecological status of one or two stations as moderate or poor, based on the relative abundances of ecological and zoogeographic groups, respectively. A total of 21 alien species were found to be associated with the mussel bed, of which Syllis ergeni is being newly considered as a new established alien species for the Mediterranean Sea. The maximum density of associated alien species was calculated as 30,300 ind m−2. The alien species assemblages were greatly affected by salinity and total inorganic nitrogen.
The aim of this study was to evaluate the dynamic thiol–disulphide homeostasis as an oxidative stress parameter, using a newly proposed method, in patients with Alzheimer’s disease.
In total, 97 participants were included in the study. Among them, 51 had been diagnosed with Alzheimer’s disease, and the remaining 46 were healthy individuals. Total thiol (–SH+–S–S–) levels and native thiol (–SH) levels in serum of each participant were measured. The amount of dynamic disulphide bonds (–S–S–) and (–S–S–) ×100/(–SH), (–S–S–) ×100/(–SH+–S–S–), and –SH×100/(–SH+–S–S–) ratios were calculated from these values. The obtained data were used to compare Alzheimer’s disease patients with healthy individuals.
The average total thiol and native thiol levels of patient with Alzheimer’s disease in the study were found to be significantly lower than those levels of healthy individuals. In addition, in the patient group, the –S–S–×100/–S–S+–SH ratio was found to be significantly higher, whereas the –SH×100/–S–S+–SH ratio was found to be significantly lower compared with healthy individuals. Total thiol and native thiol levels, dynamic disulphide bond amount, and –S–S–×100/–SH, –S–S–×100/–S–S+–SH, and –SH×100/–S–S+–SH ratios were not found to be correlated with mini mental state examination score or duration of disease.
Recent studies have shown that oxidative stress is the one of the molecular changes underlying the pathogenesis of Alzheimer’s disease. In this study, we have investigated the dynamic thiol–disulphide homeostasis in patients with Alzheimer’s disease, using a novel method.
To investigate whether cochlear involvement is an extraintestinal manifestation in patients with ulcerative colitis.
Forty-four ulcerative colitis patients and 44 age-matched healthy subjects were included in the study. Pure tone and speech audiometry, and distortion product otoacoustic emission tests were performed on all participants. The audiometric test results were compared between groups and their relationship with disease activity was investigated.
Pure tone threshold averages were significantly higher in ulcerative colitis patients compared to controls (p < 0.05). Speech discrimination scores were significantly lower in ulcerative colitis patients compared to controls (p < 0.05). Distortion product otoacoustic emission amplitude values were significantly lower for all of the tested frequencies (except for 6000 Hz in the right ear) in ulcerative colitis patients compared to controls (p < 0.05). No relationship was detected between audiometric test results and disease activity (p > 0.05).
Even though hearing thresholds may be within normal limits, decreased distortion product otoacoustic emission amplitude values indicate a cochlear involvement in ulcerative colitis patients.
The article deals with the decline in the military's influence on the foreign and security policy making process in Turkey. Turkey's harmonization process with the EU that gained momentum in the early 2000s and the US invasion of Iraq in April of 2003 seem to have played a key role in this transformation. While the EU reforms provided for the gradual elimination of legal prerogatives of the military, the increasing US influence in Iraq limited the military's operational power and led to a situation in which it could not exert influence in Northern Iraq, a key area for Turkeys security.
The Turkish retail industry is experiencing a transformation towards larger-scale retailing. This restructuring has occurred at a time when an assertive corporate private sector has begun to look ready to take the leading role from the state in the development process; and when efforts (real and perceived) towards a cautious and gradual retreat of the state from economic activities have been intensified. This paper addresses the transformation and, because of the above mentioned simultaneity, places substantial emphasis on the role of the state in the development process and in the changes recently experienced in the distribution system. In the process, the paper compares the Turkish experience with those of other countries in which the role of the state has been far-reaching.
This paper examines the degree to which political connections affect business rankings through a statistical analysis of Turkey's industry rankings between 2003 and 2011. The analysis demonstrates that business performance is associated with connectedness through industry and firm level data. We show that political connectedness varies according to the firm's channel of access to obtain favouritism either through direct personal ties or institutional networks. Ideological motivations emerge to be significant in mobilizing, shaping and tying firm behaviour to broader political agendas. In the conclusion we discuss the impact of deepening connectedness on long-term business fortunes and political institutions.
In this study, we aimed to find out whether sexual dysfunction in patients with Parkinson’s Disease (PD) was associated to PD-related disability and whether this relationship was modulated by depressive and anxiety symptoms.
Eighty-nine consecutive patients with idiopathic PD who attended to our movement disorders outpatient clinics between January 2011 and June 2014 were included in this study. The diagnosis of PD was confirmed by a movement disorders specialists in Neurology, according to UK Parkinson’s Disease Society Brain Bank Criteria. The Unified PD Rating Scale (UPDRS) motor was used to assess motor disability and Hoehn and Yahr stage (H&Y) was used to establish disease severity. Cognitive function was assessed by the Mini-Mental State Examination. Patients were also administered the Hamilton depression (HAMD) and anxiety (HAMA) rating scales. The sexual functions of the patients were rated by applying the Turkish version of the Arizona Sexual Experiences Scale (ASEX).
The mean age at the time of the study visit was 67.74±9.05. Male/female ratio was 1.87. Mean UPDRS total was 29.06±13.96 and mean UPDRS motor was 17.62±9.07. Mean HAMD score was 13.92±10.86, 58.4% of the patients had minor or major depression; and mean HAMA score was 7.94±6.49, 56.2% of the patients had minor or major anxiety. The mean ASEX score was 18.54±7.27 out of a maximum of 30. ASEX total scores were correlated with age, H&Y stage and HAMA scores. Age and also age at onset were correlated with ASEX subdomains except sexual desire. There was no correlation between disease duration and ASEX subdomains. UPDRS motor score was correlated with erection/lubrication. HAMD was only correlated with orgasm satisfaction. HAMA score was correlated with stimulation and orgasm.
In patients with PD, there may be a common factor that modulates both depression, anxiety and sexual function. Further studies are needed to clarify the exact relationship.